Holistic Therapies for Stress Relief / Kinchen, 6

OUTLINE REVIEW ARTIKEL

Loerzel DALAM JURNAL

Disusun untuk memenuhi tugas mata kuliah

KOMUNITAS

Dosen Pengampu : Ns. Sri Wahyuni, M.Kep., Sp.Kep.Kom

Oleh :

ZUNANDA HANDRIE LUKMAN 1711011088

PRODI S1 KEPERAWATAN
FAKULTAS ILMU KEPERAWATAN
UNIVERSITAS MUHAMMADIYAH JEMBER
2020
 Holistic Therapies for Stress Relief / Kinchen, 7
Loerzel
OUTLINE REVIEW ARTIKEL DALAM JURNAL

A. PENULIS ARTIKEL JURNAL

Elizabeth V. Kinchen, PhD, RN, AHN-BC, Victoria Loerzel, PhD, RN, OCN
University of Central Florida
B. JUDUL
Nursing Students’ Attitudes and Use of Holistic Therapies for Stress Relief
C. NAMA JURNAL, HALAMAN
Journal of Holistic Nursing. Volume: 37 terbitan: 1, halaman: 6-17. Artikel pertama diterbitkan
online : 8 Maret 2018 ; Masalah yang diterbitkan: 1 Maret 2019.
DOI 10.1177/0898010118761910.
D. BESARNYA MASALAH
Menjelajahi strategi siswa untuk mengatasi stres di lingkungan pendidikan adalah penting karena
sebagian besar siswa mengalami stres dalam program akademik dan menemukan cara untuk
mengurangi stres dan mempromosikan perilaku sehat dalam populasi ini dapat meningkatkan
kinerja kerja dan sekolah, meningkatkan keseluruhan kesehatan, dan berkontribusi untuk
menciptakan dan memelihara praktik kerja dan lingkungan yang sehat di masa depan. Terapi
alternatif berbiaya rendah yang membantu mahasiswa keperawatan mengembangkan keterampilan
perawatan diri dan koping juga mungkin berharga dalam menghadapi berbagai situasi kehidupan di
dalam dan di luar pengaturan pendidikan dan praktik.Perawatan diri oleh perawat dianggap dasar
untuk hasil praktik terbaik dan lingkungan kerja yang sehat oleh organisasi keperawatan terkemuka
dan entitas pemerintah.

Dalam artikel disebutkan bahwa pentingnya mahasiswa keperawatan untuk mengelola atau
memanajement stress dikarena ketika seseorang tidak bisa beradaptasi dalam pengelolaan stress
akan menimbulkan kurangnya efektif dalam proses pembelajaran atau ketika sudah bekerja kinerja
akan menurun saat tidak dapat beradaptasi dalam mengelolaan stress.

E. URGENSI MASALAH
iswa keperawatan diketahui mengalami stres saat terdaftar dalam program pendidikan, yang dapat
memengaruhi kemampuan mereka untuk memenuhi harapan pendidikan dan klinis, serta yang
timbul dalam lingkungan praktik masa depan. Strategi farmasi dan perilaku umumnya digunakan
 Holistic Therapies for Stress Relief / Kinchen, 8
oleh siswa untuk mengelola dan mengurangi stres, tetapi terapi holistik mendapatkan landasan
Loerzel
sebagai alternatif yang hemat biaya dan aman. Dalam komponen kualitatif studi metode campuran
ini, mahasiswa keperawatan ditanyai pertanyaan awal mengenai keterbukaan mereka untuk
menggunakan atau merekomendasikan terapi holistik atau komplementer, strategi yang mereka
gunakan untuk mengelola stres sekolah atau kerja, dan persepsi mereka tentang dampak terapi
holistik terhadap kesehatan pribadi.
F. METODE
Artikel ini melaporkan data kualitatif sebagai komponen studi yang lebih besar, eksperimental semu,
metode campuran. Studi yang lebih besar mengukur dampak intervensi yoga terhadap stres, belas
kasih diri, dan kualitas hidup perawat siswa. Desain studi metode campuran dipilih karena
memungkinkan pengukuran dampak intervensi yoga, serta permohonan pandangan perawat siswa
tentang penggunaan dan pentingnya terapi holistik pada tekanan akademik dan kehidupan ketika
terdaftar di sebuah program keperawatan. Mengingat sifat yang ditentukan dari program pendidikan
keperawatan, input siswa sangat berharga untuk mengukur dan mengatasi apa yang paling penting
bagi siswa ketika merencanakan, merevisi, dan mengevaluasi kurikulum keperawatan, terutama
karena penambahan konten pada perawatan diri direnungkan dan diimplementasikan. 
Peserta menyelesaikan survei kuantitatif awal dan juga pertanyaan-pertanyaan terbuka yang
dikembangkan oleh investigator kualitatif yang mengeksplorasi keterbukaan mereka untuk
menggunakan atau merekomendasikan terapi holistik untuk menghilangkan stres, strategi yang
mereka gunakan untuk mengelola stres dari sekolah atau pekerjaan, dan persepsi mereka tentang
dampak holistik. atau terapi komplementer pada kesehatan pribadi. Kami melaporkan analisis
respons pertanyaan terbuka awal di sini. 
G. HASIL
Temuan dari penelitian ini memiliki implikasi penting bagi siswa dalam program pendidikan
keperawatan, karena mereka mendukung penggunaan terapi holistik untuk kesehatan siswa,
menyoroti pentingnya peningkatan keterampilan koping dalam pengaturan pendidikan, dan
mendukung kursus yang memberikan paparan terapi holistik dalam kurikulum pendidikan.
Menemukan cara bagi perawat siswa untuk mengatasi stres dengan meningkatkan penggunaan
praktik holistik mungkin memiliki nilai tidak hanya untuk menavigasi tuntutan lingkungan didaktik
dan klinis tetapi juga sebagai teknik untuk mengelola situasi kehidupan dan pemicu stres lainnya,
berkontribusi pada pengembangan perawat yang diberdayakan. mempertimbangkan semua aspek
seseorang ketika merawat diri sendiri dan orang lain
H. PEMBAHASAN
Studi ini menambah pengetahuan seputar strategi yang digunakan siswa keperawatan untuk
menghilangkan stres, dan menyoroti kebutuhan untuk penelitian lebih lanjut tidak hanya dalam
 Holistic Therapies for Stress Relief / Kinchen, 9
penggunaan terapi holistik tetapi juga dalamLoerzel
kegiatan lain yang diidentifikasi oleh siswa untuk
menghilangkan stres. Selain itu, penelitian yang menggunakan studi intervensi dan yang
menampilkan metodologi penelitian lain diindikasikan untuk lebih mengeksplorasi alternatif
perawatan medis tradisional untuk stres pada populasi perawat siswa, serta pada populasi dan
pengaturan lain.

A. SARAN
Menurut saya untuk artikelnya yang ditulis sudah sangat baik, akan tetapi bilamana ditambahkan
terkait dengan seberapa besar dampak penggelolaan stres terhadap mahasiswa keperawatan dengan
angka dan dijelaskan secara detail terkait metode sehingga didapat hasil yang akurat mungkin akan
lebih baik.
 Holistic Therapies for Stress Relief / Kinchen, 10
Lampiran Jurnal Loerzel

jhn
Qualitative Research

Nursing Students’ Attitudes and Use of

Holistic Therapies for Stress Relief Journal of Holistic Nursing

American Holistic Nurses

Association
Elizabeth V. Kinchen, PhD, RN, AHN-BC Victoria Volume 37 Number 1
Loerzel, PhD, RN, OCN
March 2019 6–17

University of Central Florida © The Author(s)

2018 Article reuse guidelines:
sagepub.com/journals-
permissions
10.1177/0898010118761910
journals.sagepub.com/home/jhn

Purpose: The purpose of this study was to explore student nurses’ openness to using or
recommending holistic therapies, the strategies they use to manage stress from school or work,
and their perceptions of the impact of holistic therapies on personal health. Study Design:
Qualitative component of a quasi- experimental, mixed-methods study. Methods: A convenience
sample of undergraduate nursing stu- dents in a southeastern U.S. university completed baseline
surveys, including demographics and three open-ended questions regarding attitudes toward
holistic therapies and strategies used for stress man- agement. Qualitative thematic analysis was
undertaken to identify recurring themes in textual data. Findings: Students are open to using or
recommending holistic therapies but identify lack of knowledge and lack of time as barriers to their
practice. Among strategies used by student nurses to manage stress from school or work were
physical activity, prayer and meditation, time management, distraction, socialization, artistic
pursuits, animal interactions, and other activities. Themes describing holistic therapies’ impact on
personal health were wholeness, self-empowerment, relaxation/restoration, and
alternative/complement to traditional medicine. Conclusions: Findings indicate receptiveness by
stu- dent nurses to the use of holistic therapies but point to the need for the inclusion of
informational as well as experiential education on holistic therapies within nursing curricula.

Keywords: students; group/population; alternative/complementary therapies; common themes; stress

and coping

Student nurses’ experience of stress while

performance, clinical challenges, death and suffering
enrolled in educational programs is well documented
of patients, self- and family/peer expectations,
in the global literature (Ashcraft & Gatto, 2015;
changes in environment and eating habits, lack of
Capp & Williams, 2012; Cleary, Horsfall, Baines, &
support from clinical facility personnel, lack of
Happell, 2012; Crary, 2013; Drew et al., 2016;
monetary resources, future prospects, fear of clinical
Dutta, Pyles, & Meiderhoff, 2005; Fornes-Vive,
incompetence, inti- mate relationship strain, clinical
Garcia-Banda, Frias-Navarro, & Rosales-Viladrich,
workload, relation- ships with patients and families,
2016; Galbraith & Brown, 2011; Galbraith, Brown,
and work–life balance (Beck, Hackett, Srivastava,
& Clifton, 2014; Gibbons, Dempster, & Moutray,
McKim, & Rockwell, 1997; Beddoe & Murphy,
2011; Graham, Lindo, Bryan, & Weaver, 2016;
2004; Crary, 2013; Galbraith & Brown, 2011;
Hensel & Laux, 2014; Jiminez, Navia-Osorio, &
Galbraith et al., 2014; Gibbons et al., 2011; Kim,
Diaz, 2009; Li & Lambert, 2008; Nevins & Sherman,
2014; Li & Lambert, 2008; Moscaritolo,
2016; Suresh, Matthews, & Coyne, 2013); however,
strategies to prevent, manage, and alleviate education- 2009; Rhead, 1995; Timmins & Kaliszer, 2002; Van
related stressors have not been fully explored.
Stressors to which nursing students are particu-
Authors’ Note: Please address correspondence to Elizabeth
larly vulnerable include concerns about academic V. Kinchen PhD, RN, AHN-BC, Assistant Professor, Nursing,
 Holistic Therapies for Stress Relief / Kinchen, 11
University of Central Florida, 12201 Research Parkway, Suite
300, Orlando, FL 32826, USA; e-mail: Loerzel
elizabeth.kinchen@ucf.edu.
 der Riet, Rossiter, Kirby, Dluzewska, & Harmon,
2015; Watson et al., 2008).
These stressors can have significant effects on a
student’s ability to navigate educational and clinical
environments, often contributing to “burnout,”
dissat- isfaction, and attrition in the profession (Aiken,
Clarke, Sloane, Sochalski, & Silber, 2002; Asuero et al.,
2014; Beck et al., 1997; Crary, 2013; Goodare, 2017;
Huntington et al., 2011; Rogers, Hwang, Scott, Aiken,
& Dinges, 2004). In addition, the demands of didactic
and clinical education leave little time for faculty to
directly teach students self-care strategies (Newsome,
Waldo, & Gruszka, 2012; Yildirim et al., 2010).
Strategies traditionally used by students to
alleviate
educational stress may take the form of pharmaceuti-
cal, psychological, or behavioral therapies (Carroll,
McLaughlin, & Blake, 2006; Coleman et al., 1997;
Herman et al., 2011; McCabe, Teter, Boyd, Knight,
& Wechsler, 2005; Teter, McCabe, LaGrange,
Cranford, & Boyd, 2006). Yet there is a growing
body of knowl- edge regarding the use of holistic
therapies for stress- related challenges in nursing and
health care programs (Avino, 2011; Beddoe &
Murphy, 2004; Camurdan & Gul, 2013; Capp &
Williams, 2012; Crary, 2013; Escuriex & Labbe,
2011; Feldman & Laura, 2004; Galbraith & Brown,
2011; Galbraith et al., 2014; James, Bah, &
Kondorvoh, 2016; Kim, 2014; Laurenson,
MacDonald, McCready, & Stimpson, 2006; Lindop,
1993; Padykula, 2017; Prasad, Varrey, & Sisti, 2016;
Rosenweig, Reibel, Greeson, Brainard, & Hojat,
2009; Smith, Greer, Sheets, & Watson, 2011; Uzun
& Tan, 2004; Van der Riet et al., 2015; Warnecke,
Quinn, Ogden, Towle, & Nelson, 2011; Yildirim et
al., 2010), and such studies continue to prompt
further inquiry in university settings. Mindfulness
programs such as meditation and yoga; body-based
methods such as massage, chiropractic, and
acupuncture; and energy therapies such as therapeutic
touch are garnering interest as alternatives to
established interventions, especially pharmaceutical
preparations, which are costly and potentially
problematic in clinical and edu- cational
environments (Galbraith & Brown, 2011; Herman et
al., 2011; McCabe et al., 2005; Teter et al., 2006;
Yildirim et al., 2010).
Significance of the Study for
Nursing
Exploring students’ strategies to counteract
stress in educational environments is important
because most students experience stress in
academic programs and finding ways to reduce
stress and pro- mote healthy behaviors in this
population could improve work and school
performance, enhance overall health, and contribute
to creating and main- taining future healthy work
practices and environ- ments. Low-cost alternative
therapies that help nursing students develop self-
care and coping skills may also be valuable in
dealing with a variety of life situations in and out
of educational and practice set- tings.
Self-care by nurses is considered to be founda-
tional to best practice outcomes and healthy work
environments by leading nursing organizations and
governmental entities (American Association of
Colleges of Nursing [AACN], 2008; American
Nurses Association [ANA], 2008, 2010, 2015a,
2015b; American Holistic Nurses Association
[AHNA] & ANA, 2013; Institute of Medicine,
2004), as caregiver stress and fatigue (including
compassion fatigue) in healing environments has
been associated with high turnover rates, slowed
reaction time, lapses in attention, errors, reduced
capacity for problem solving, and decreased
motivation and energy (ANA, 2015b, p. 5; Institute
of Medicine, 2004, p. 12).
The AACN (2008), in its Essentials of
Baccalaureate
Education for Professional Nurses, cites practice
from a holistic, caring framework, as well as
engaging in care of self to care for others, as
being central to improving health care outcomes (p.
8). The ANA (2008, 2010, 2015a, 2015b)
recognizes the effects of stress on nursing practice
and patient outcomes and contends that nurses owe
the same duty to self as to others; this includes the
promotion of health and safety, continuing personal
and professional growth, addressing and modeling
self-care processes, and engaging in self-study and
reflection. The AHNA (AHNA & ANA, 2013) also
considers self-reflection, self-assessment, self-care,
healing, and personal development as necessary for
service to others, as these activities demonstrate
reverence for the nurse’s own life and commitment
to nursing as a life calling. Furthermore, recruitment
and retention of nurses continue to be problems in the
profession (Aiken et al., 2002; Goodare, 2017;
Huntington et al., 2011; Lu, Barriball, Zhang, & While,
2012; Milliken, Clements, & Tillman, 2007; Yeager &
Wisniewski, 2017), so pre- paring student nurses to
deal with the stresses likely to be encountered in
practice and finding ways to foster positive workplace
cultures are essential to attracting
 Holistic Therapies for Stress Relief / Kinchen,
Loerzel
and retaining newly licensed nurses (Cohen-Katz,
Wiley, Capuano, Baker, & Shapiro, 2004; Cranick,
Miller, Allen, Ewell, & Whittington, 2015; Edward &
Hercelinskyj, 2007).
The need to address educational stress, with a
view to improving work and school performance,
enhancing overall health, and creating and
maintaining future healthy work practices and
environments, underscores the importance of self-
care strategies for nursing stu- dents, especially as
students are introduced to care expectations in
clinical and didactic courses and pre- pare for
transition to professional practice.
Method
This article reports qualitative data as a compo-
nent of a larger, quasi-experimental, mixed-
methods study. The larger study measured the
impact of a yoga intervention on student nurses’
stress, self- compassion, and quality of life. A
mixed-methods study design was chosen because
it allowed meas- urement of the impact of the yoga
intervention, as well as solicitation of student
nurses’ views on the use and importance of
holistic therapies on aca- demic and life stress
while enrolled in a nursing program. In view of
the prescribed nature of nursing educational
programs, student input is valuable for gauging and
addressing what is most important to students when
planning, revising, and evaluating nursing
curricula, especially as additions of content on self-
care are contemplated and implemented.
Participants completed baseline quantitative
surveys as well as qualitative, investigator-
developed open-ended questions exploring their
openness to using or recommending holistic
therapies for stress relief, the strategies they use to
manage stress from school or work, and their
perceptions of the impact of holistic or
complementary therapies on personal health. We
report the analysis of baseline open- ended
question responses here.
Research questions guiding the qualitative por-
tion of the study were as follows:
1. How open are nursing students to
using or recommending holistic
therapies?
2. What strategies do nursing students
use to manage stress from school or
work?
3. What impact do student nurses
perceive, if any, of holistic therapies
on personal health?
8
Sampling
A convenience sample of senior undergraduate
nursing students in a single nursing course in a south-
eastern U.S. university was invited to complete base-
line surveys, including demographics and three
open-ended questions regarding holistic therapies and
strategies for stress management. To avoid the
appear- ance of coercion by the course instructor, the
principal investigator recruited potential participants
by making an independent announcement in the
course, outlin- ing the purpose and design of the
study. In collabora- tion with the course instructor,
students were offered two extra credit points in the
course for completing the baseline surveys. As an
alternate assignment, students who did not wish to
participate in the study but wanted to take advantage
of an extra credit opportunity were asked to write a
one-page essay on a holistic or comple- mentary
therapy of their choice.
Students aged 18 years or older, able to speak and
read English, and enrolled in nursing classes at the
time of study start date were included. Institutional
review board approval was obtained from the
academic institution prior to conducting this study,
and online, written consent was obtained from the
participants.
Data Collection
An email link, made available in the online
course learning management system, gave students
access to the study description, consent form, and
survey link. Completion of baseline surveys took
approximately 15 to 20 minutes.
Demographic information collected from the
participants included age, gender, and race/ethnicity.
Open-ended baseline questions were as follows:
1. In general, how open are you to using
or recommending holistic or
complementary therapies?
2. What strategies do you currently use
to manage stress from school or
work?
3. What do you think the impact of
holistic or complementary therapies is
on personal health?
Data Analysis
Responses to Question 1 were analyzed using
descriptive statistics (frequencies), as responses fell
into three categories: “open,” “somewhat open,”
and

Figure 1. Sample age distribution in years.
Figure 2. Gender distribution in the Sample.
“not open.” For Question 2, which requested par-
ticipants to name strategies used to manage stress,
responses were analyzed by identifying broad catego-
ries in the data and their frequencies.
Since Question 3 was concerned with percep-
tions of the impact of holistic therapies on personal
health, these responses provided the richest data, so
thematic analysis was undertaken to identify recur-
ring themes in textual responses. Frequencies
regarding the perception of overall impact of
holistic or complementary therapies (positive or
negative) were also tabulated for these data.
Thematic analysis was chosen because it
involves identification and reporting of themes or
patterns in
Figure 3. Ethnic distribution in the Sample.
textual responses, and analysis for Question 3 fol-
lowed the procedures described by Braun and Clarke
(2006). After initial reading and rereading of
responses to foster familiarization with the data,
categories were developed and higher order themes
were identified. An initial coding framework was
generated by each of the two researchers; responses
were categorized separately by the researchers, and
results were compared. Collaborative reexamination
and reflection on the categories was ongoing and
involved a dynamic process of discussing, combin-
ing, and re-creating data categories to discern over-
arching themes. Evidence supporting the
researchers’ interpretive decisions is illustrated in
the Findings section, with verbatim examples from
participants.
Findings
Demographics
The sample (n = 116) was predominantly female
(87%), Caucasian (75%), and between the ages of 19
and 25 (80%). Thirteen percent of the sample was
male. Eight percent of the respondents identified as
Asian, 8% as African American, 1% as Native
Hawaiian/ Pacific Islander, and 8% as representing
other ethnici- ties. The largest percentage of the
sample was between the ages of 19 and 25 (80%).
Ten percent were older than 50 years, 7% were
between 26 and 35 years, and
3% were between 36 and 50 years. Sample character-
istics are presented in Figures 1, 2, and 3.
Open-Ended Question Responses
Question 1: Openness to Using/Recommending Holis-
tic/Complementary Therapies. The majority of stu-
dents (70%) expressed themselves as being “very
open” or “open” to using or recommending holistic
Figure 4. Strategies used to manage stress from school or work.
therapies. Those who were “somewhat open”
accounted for 28% of the sample, and 2% of the sam-
ple were not open to using or recommending holistic
therapies.
Among those open to using or recommending
holistic practices, a few participants identified barri-
ers to their prospective use: lack of time and lack of
knowledge. “Lack of time” was exemplified in state-
ments such as “I’m very open to them but I just
never have the time to start them and see if they
work for me” and “I’m very open to using holistic or
complementary therapies, there just have not been
optimal time or dates for me to practice.” Examples
of responses describing “lack of knowledge” were
“moderately open, not 100% sure what holistic
therapy entails” and “If I knew more about the dif-
ferent options I would be open to recommending
them.”
Question 2: Managing School or Work Stress.
While there were 116 respondents to this question,
many students reported using more than one
activity to manage stress from school or work, so
224 responses were considered in analysis.
Responses were grouped into the following eight
categories: physical activity, prayer and meditation,
time management, distrac- tion, socialization,
artistic/creative pursuits, interac- tions with
animals, and other activities. Figure 4 summarizes
frequencies in these responses.
Activities within the physical category included
“working out” or exercising, running, walking, and
organized sport participation.
The prayer and meditation category included
the reading of sacred texts, worship, praying,
medita- tion, deep breathing, yoga, relaxation, and
mental imagery. These activities were grouped
together as they were seen as representing the
concentration of
attention inward on a spiritual state or source of
strength.
Time management activities included not only
the mental planning of school- and work-related
activities but also the use of organizational aids
such as calendars, lists, and schedules. Taking
breaks and “working ahead” on educational
assignments were also grouped under this category,
as they were seen as relating to the use of time for
accomplishing school- or work-related activities.
Distractions were categorized as activities used
to “take one’s mind off” the stressor. Students
reported using movies, television, reading,
shopping, cooking, driving, gardening, listening to
music, and playing video games as distractions
from stress- inducing situations at school or work.
Listening to music was originally categorized as an
artistic pur- suit but was reassigned to the
distraction category as it was perceived by
researchers to be more passive than creative an
activity.
Being with friends and/or family, and using
social media or “apps,” represented the socialization
category. This category included talking to and see-
ing friends and family, “hanging out,” and spending
time with others in face-to-face (“live”) as well as
virtual interactions.
Artistic and creative pursuits were categorized
as drawing, coloring, playing music, dancing, and
writ- ing. Interactions with animals as a strategy
for man- aging stress from school or work included
playing with, petting, or walking pets (dogs).
Other strategies that students reported using to
manage stress (that did not fit within the previously
named categories) included such diverse activities as
sleeping or napping, “stress eating,” bathing or
showering, therapy and/or medications, going to the
beach or taking a day off, and crying.
 Of the eight categories, five are traditionally
considered to be holistic therapies: physical
activity, prayer and meditation, distraction, artistic
and crea- tive pursuits, and animal interactions
(Lindquist, Snyder, & Tracy, 2014; Mariano, 2013;
McElligott, 2013; Mornhinweg & Voignier, 1995).
Categories representing holistic therapies used by
students for stress management accounted for more
than half (62%) of the responses, with categories of
activities other than holistic therapies constituting
only 38% of the responses.
Question 3: Impact of Holistic Therapies on
Personal Health. Responses to this question were
of two sorts: some respondents identified an
overall impact of holistic therapies on health
(positive, negative, or uncertain), while others
identified specific ways in which they perceived
holistic therapies to affect per- sonal health. Some
students offered information about their personal
experiences in using holistic therapies to manage
specific health conditions such as attention deficit
disorder, migraines, and anxiety.
Overall Impact. An overwhelming majority of students
(73%) reported viewing holistic therapies as having a
positive overall impact on personal health, while others
perceived a potential or conditional impact or were
unsure of the effect of holistic therapies on health
(22%). Very few respondents (5%) perceived holistic
therapies to have no effect on personal health.
Specific Impacts. More than half of the
respondents to this question identified quite
specific impacts of holistic therapies on health,
with comments varying in length from a few words
to several sentences. Coding by both researchers
initially produced gen- eral agreement on
categories of impact: emotional/ physical/spiritual/
or mind/body/soul, relaxation or stress reduction,
addition or alternative to traditional medicine, and
self-improvement or self-control. These descriptive
codes were then grouped into themes, which
necessitated a process of collabora- tive recoding
of some responses, until consensus was reached
and researchers identified four recurring themes in
the data: wholeness, self-empowerment,
relaxation/restoration, and alternative/complement
to traditional medicine.
Wholeness. Wholeness related to being more
than a student; students who perceived benefits of
holistic therapies described being a multidimen-
sional person and stated that using holistic therapies
for stress reduction made them feel like a more bal-
anced person. Some students recognized the adverse
effects of stress on health and expressed that holistic
therapies could be used to manage more than physi-
cal ailments. Several students commented on the
mind, body, spirit connection; one student com-
mented that holistic therapies offered a “chance to
harmonize one’s mind, body, and soul.” Another
student described having a “feeling of wholeness”
when she used holistic therapies to reduce her
stress. Both comments illustrate that students can
feel out of balance when they experience stress in
educational environments and that holistic practices
address all aspects of their person, thus offering an
opportunity for achieving balance in their lives.
Self-empowerment. Many students mentioned
that holistic therapies made them feel empowered
over their own personal health. Holistic therapies
were seen as a way to take charge of their overall
health, which again included the physical, emotional,
and spiritual aspects of being. One participant shared
that holistic practices gave her a “greater feeling of
self-control over personal health.” Another stated that
holistic practice “decreased stress and increased self-
awareness, confidence and esteem.” These comments
imply that in stressful educational environments stu-
dents may feel that they have limited power over
maintaining their health and that holistic therapies
provide a means of not only acknowledging health
issues but of taking positive action to improve them.
Relaxation/restoration. Some students used
holistic therapies to decompress from the stresses of
the day and focus on relaxation and restoration. This
theme was also associated with caring for the mind,
body, and spirit. One student felt that de-stressing
and relaxing reduced other negative effects in their
body. Others appreciated quiet time in meditation,
where “the center of attention is on yourself only
and not the million other things in our daily lives,”
and expressed that holistic activities made the “mind
and body relax, rejuvenate, and refocus.” Feeling
rejuvenated is an especially important benefit of
holistic therapies for student nurses, as educational
programs are frequently fast-paced, rigorous, and
demanding, so activities that can renew one’s energy
and purpose have obvious value.
 Alternative/complement to traditional medicine.
Finally, participants recognized the benefits of holistic
therapies compared with traditional medicine. They
saw holistic therapies as an adjunct, alternative, or
complement to traditional medicine and, again, alluded
to their effects on the mind, body, and spirit. One
respondent believed that holistic therapies improved
an individual’s health “in a way no traditional
medi- cine can.” Another saw them as an opportunity
to “positively impact personal health for those who
tra- ditional medicine has not helped.” These
responses support the use of holistic therapies as ways
to man- age stress in educational programs without the
use of stimulants, sedatives, or other pharmacological
agents and as adjuncts or replacements for more
traditional medical treatments.
The themes surrounding holistic therapies’
impacts on personal health not only described a
range of benefits for student nurses but also repeat-
edly included references to the empowering and
restorative effects of holistic activities on the whole
person: mind, body, and spirit.
Discussion
Nursing students are known to experience
stress while enrolled in educational programs,
which may affect their ability to meet educational
and clinical expectations, as well as those arising
in future prac- tice environments. Pharmaceutical
and behavioral strategies are commonly used by
students to manage and alleviate stress, but holistic
therapies are gaining ground as cost-effective and
safe alternatives. In this qualitative component of a
mixed-method study, nursing students were asked
baseline questions regarding their openness to
using or recommending holistic or complementary
therapies, the strategies they used to manage
school or work stress, and their perceptions of the
impact of holistic therapies on personal health.
An overwhelming majority of students were open
to using and/or recommending holistic and comple-
mentary therapies, although lack of knowledge and
lack of time were seen as barriers to their use. Such
responses indicate receptiveness by student nurses
to the use of holistic therapies but point to the need
for the inclusion of informational as well as experi-
ential education on holistic therapies within
nursing curricula. Academic content describing and
demon- strating holistic therapies would enable
students to gain knowledge and exposure to the
potential
benefits of holistic therapies for stress relief and
health maintenance for themselves and for their
patients.
Students also reported using a wide variety of strat-
egies to manage school- or work-related stress. Of
these, most were recognized holistic therapies: physical
activity, prayer and meditation, distraction, creative
and artistic pursuits, and animal interactions (Lindquist
et al., 2014; Mariano, 2013; McElligott, 2013;
Mornhinweg & Voignier, 1995). However, many stu-
dents identified using time management, socialization,
and other activities for stress relief, so inquiry into the
efficacy of holistic as well as other, “nonholistic,”
activities for stress relief is indicated. Exploring which
activities students consider to be holistic and present-
ing evidence that supports strategies for stress reduc-
tion may be especially helpful to students experiencing
stress in nursing programs. Interventional studies fea-
turing student-identified activities for stress relief may
also prove useful in devising ways to enhance and
enrich nursing program curricula.
Respondents cited many beneficial effects of
holistic therapies for personal health, and themes
identified in these responses suggest that holistic
therapies promote wholeness, provide relaxation and
rejuvenation, empower students to take control of
their health, and have value as alternatives or com-
plements to traditional medicine. Further research
into the effects of holistic therapies on personal
health, especially in student nurse populations, is
recommended. Inquiry in this area may not only
inform student nurses’ health-seeking behaviors but
also increase student knowledge in teaching and
recommending holistic therapies to patients, as
adjuncts to existing medical treatments.
Findings from this study support and mirror previ-
ous research findings on holistic therapies in this
population (Avino, 2011; Camurdan & Gul, 2013;
James et al., 2016; Laurenson et al., 2006; Uzun &
Tan, 2004; Yildirim et al., 2010), especially with
regard to nursing students’ interest in and use of
holistic therapies. This study, however, expanded the
under- standing of nursing students’ attitudes and
use of holis- tic therapies to include their perception
of the benefits of holistic therapies on personal health
and their open- ness to recommending them to
others.
Limitations
As with any research, this study had
limitations. It used a convenience sample from one
university
setting, and respondents were predominantly
values, developing inner strength and personal
female, Caucasian, and between the ages of 19 and
growth, and acquiring the knowledge and skills
25. This sampling distribution, while mirroring
required to practice professional nursing (p. 19).
those of pre- vious studies on nursing students’
Studies exploring the inclusion of holistic and
use of holistic therapies, and those of nursing
complementary therapy content for self-care in
programs in general, limits transferability of the
health care curricula have reported effects such as
results to other groups and settings. In addition,
enabling students to find ways of handling stress
participants were aware that the study addressed
and supporting the health of self and others (Booth-
the use of holistic therapies for stress relief and that
Laforce et al., 2010; Capp & Williams, 2012;
the researchers were faculty in the undergraduate
Chann & Schaffrath, 2017; Cino, 2016;
nursing program, so response bias may have
Horneffer, 2006;
influenced students’ replies. The researchers’
Kreitzer et al., 2008; Little, 2013; Moore, 2010;
assumptions related to participants’ knowledge of
Padykula, 2017; Prasad et al., 2016; Riley &
holistic therapies may also have been a factor in
Yearwood, 2012; Rosenweig et al., 2009; Van der
introducing bias, as students’ definitions of
Riet, Francis, & Levett-Jones, 2011; Warnecke et
holistic therapies were not solicited or explored
al., 2011). These findings support the creation of
and may have differed from those of the
non- elective nursing courses that directly address
researchers. These limitations highlight the need
self- care strategies for students and that have
for further study regarding students’ knowledge
dedicated space in nursing curricula. A core
and use of holistic practices and for research using
curriculum nurs- ing course featuring self-care
more diverse settings and samples.
content is also sup- ported by recommendations
from the AHNCC (2017), wherein the AHNCC
cites a basis in the sciences of health, wellness, and
Implications for Nursing Education wellbeing, and attention to all patterns of knowing
as sources of information for the profession (p. vi).
The reported attitudes and use of holistic thera-
A course dedi- cated to self-care for nurses would
pies by students for stress reduction while enrolled
not only address lack of knowledge and lack of
in nursing educational programs prompts a discus-
time as barriers to the consideration of holistic
sion regarding the need for inclusion of this content
therapies for stress relief in academic programs, it
in nursing program curricula. Findings from this
would also demonstrate the importance of self-care
study have important implications for nursing edu-
to students. Additionally, content in such a course
cation, particularly in view of recommendations
could be used to inform patient-centered and
from leading health care organizations regarding the
culturally appropriate care for newly graduated
inclusion of informational as well as experiential
nurses and provide them with strat- egies for
holistic and self-care content in educational pro-
coping with potentially stressful practice
grams. The American Holistic Nurses Credentialing
environments.
Corporation (AHNCC, 2017) and the AHNA and
ANA (2013) cite education from a holistic nursing
perspective as foundational for both generalist and
advanced nursing education and call for the addition Proposed Course Framework
of content addressing holistic relationship-centered
philosophies, as well as self-care modalities, to exist- The AHNA (Mariano, 2013) calls for nurses to
ing curricula. The Carnegie Foundation (Benner, empower others by teaching them techniques to reduce
Sutphen, Leonard, & Day, 2010) recommends teach- their stress, and the themes identified in this qualita-
ing “the ethos of self-care” and the skills of tive study may indeed serve as a framework for content
inquiry, research, and reflection in nursing in a core curriculum self-care nursing course.
educational pro- grams, and the AHNCC (2017), in “Wholeness,” “self-empowerment,” “relaxation/restora-
close alignment with and expanding on the tion,” and “alternative/complement to traditional
Essentials of Baccalaureate Nursing Education medi- cine” represent key elements in the core values
(AACN, 2008), identifies con- templative practice, of holistic nursing (Mariano, 2013). In Core Value 2:
self-reflection, self-awareness, and self-care as Caring Process, attention to wholeness is described as
foundational to refining personal recognizing the “totality of the human being” and
the “interconnectedness of body, mind, emotion, spirit
. . . and environment” (p. 66). Self-empowerment
involves
“guiding individuals to use their inner strength and
resources” and honoring the “innate capacity of
people to heal themselves” (p. 67). Focus on care
activities that “promote healing, peace, comfort,
and a subjective sense of well-being” exemplify
relaxation and restora- tion (p. 67), and the process
further calls for nurses to integrate
complementary/alternative modalities into clinical
practice, as these are activities that “broaden and
enrich the scope of nursing practice” (p. 67).
“Wholeness” as the conceptual framework for
content in such a course would include the impor-
tance of the interconnectedness of mind, body, and
spirit and the care and consideration of all areas of
a person’s existence when setting self-care goals.
Wholeness would ground learning objectives and
provide support and focus for course activities, relat-
ing wholeness to content in all other areas of nurs-
ing educational curricula.
“Self-empowerment” involves taking control
of one’s knowledge, choices, and activities. Course
objectives promoting and addressing self-empower-
ment might include identification and awareness of
life patterns and one’s innate ability to heal, through
self-assessment, reflection, and group interaction. Use
of the Integrative Health and Wellness Assessment
(Dossey, Luck, & Schaub, 2012) or Health-Promoting
Lifestyle Profile (Walker, Sechrist, & Pender, 1987),
ongoing journaling or diary keeping, and open dis-
cussion in an environment of trust and acceptance
might provide relevant content.
“Relaxation/restoration” content might include
exposure to and instruction in meditation, intention-
ality, and mindfulness activities such as yoga, breath-
ing exercises, full-body scanning, emotional freedom
technique, Qigong, and a host of other instructor-
and/or student-identified modalities. Learning would
be facilitated by guest lecturers, demonstration, and
participation in selected activities. Spirituality, or the
search for meaning in life, should also be included in
this content, as it is a topic that is often addressed
incompletely in academic and practice environments
(Kinchen, 2015). Including spirituality in a “stand-
alone” course would provide an opportunity to more
comprehensively address this important aspect of
care than is possible in other areas of the curriculum,
where time and space are often limited.
Content addressing holistic therapies as “alterna-
tive/complement to traditional medicine” might
include information on other (nonallopathic) healing
philoso- phies, such as Chinese medicine, Ayurvedic
healing,
Native American and African traditions, and other
culturally based modes of health promotion.
Knowledge in these areas may facilitate care of
patients who practice or have an interest in nontra-
ditional healing activities, allowing the nurse to
consider and honor patient preferences, beliefs, and
worldviews when providing care.
Conclusions
This study adds to the body of knowledge sur-
rounding the strategies that nursing students use for
stress relief, and it highlights the need for further
research not only in the use of holistic therapies but
also in other activities identified by students for
stress relief. In addition, research using interven-
tional studies and those featuring other research
methodologies are indicated to more fully explore
alternatives to traditional medical treatment for
stress in student nurse populations, as well as in
other populations and settings.
Findings from this study have important implica-
tions for students in nursing educational programs, as
they support the use of holistic therapies for student
health, highlight the importance of the enhancement
of coping skills in educational settings, and endorse
courses that provide exposure to holistic therapies in
educational curricula. Finding ways for student nurses
to counteract stress by increasing the use of holistic
practices may have value not only for navigating the
demands of didactic and clinical environments but
also as techniques for managing other life situations
and stressors, contributing to the development of
nurses who are empowered to consider all aspects of
a person when caring for themselves and others.
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Elizabeth V. Kinchen, PhD, RN, AHN-BC, is an assistant pro- fessor at the University of Central Florida and
a Board Certified Advanced Holistic Nurse. Dr. Kinchen’s research focuses on holistic self-care for students
and the preservation of holistic nursing values in advanced practice nursing.

Victoria Loerzel, PhD, RN, OCN is an associate professor at the University of Central Florida, and the Beat M.
and Jill L. Kahli Endowed Professor in Oncology Nursing. Dr. Loerzel’s research interests include assisting older
adults to improve qual- ity of life and self-manage cancer treatment-related side effects. She also is interested in
developing interventions to improve nursing student’s quality of life and learning experiences.